One of the most dramatic demographic changes to occur in the U.S. over the past decade and a half is the change in settlement patterns of Hispanics. Areas of the country that have little history or experience with Hispanic populations have begun to absorb new Latin American immigrants as well as internal Hispanic migrants who have moved from more traditional destinations within the U.S. to these new destinations. The changing migration patterns and resulting emergence of large communities of Hispanics in new destinations pose challenges not only for states and municipalities and their health care delivery systems, but also for the migrants themselves, particularly with regard to their ability to access quality health care. The proposed project will compare the health care experiences of working-age Mexican immigrants and U.S.-born Mexican-Americans in new destinations with those of their counterparts in more traditional destinations. We focus on people of Mexican origin because they are by far the largest group of Hispanics in the U.S. The study will use a geo-coded version of the Medical Expenditure Panel Survey Household Component (MEPS-HC) for 1996-2004, linked to contextual data from a variety of secondary data sources. The specific aims of the project are to (1) compare access, use, and quality of care for working age Mexican immigrants and U.S.-born Mexican-Americans in new destinations with those of their peers in more traditional destinations; (2) assess the extent to which characteristics of immigrants and U.S.-born Mexican-Americans and of their destinations account for any differences in access, use, and quality that we find; and (3) compare the experiences of Mexican immigrants with those of U.S.-born Mexican-Americans in new and traditional destinations. The project will be the first of its kind to use nationally representative data and to assess a wide range of measures of access, utilization, and quality of care for Hispanics in new and traditional destinations. It will also be the first to assess the contextual factors that influence these outcomes, including the capacity of the health care safety net, the availability of health care providers, the ethnic and language composition of the local population, and the local concentration of Latin American immigrants. Thus the project will make a substantial contribution to our understanding of the factors that influence access to and quality of care among Hispanics. Additionally, the findings [unreadable] will provide federal and state policymakers with much needed information on how to improve access [unreadable] and quality for the numerous Hispanics who have settled in new areas of the country. [unreadable] [unreadable] [unreadable] [unreadable]